UPMC Physician Resources

New Drug Therapy A Safe, Effective Option for Elderly Patients with Acute Myeloid Leukemia

PITTSBURGH, Dec. 8, 2014 – Seventy percent of elderly patients with acute myeloid leukemia (AML) who were treated with a combination of drugs aimed to make chemotherapy treatments effective and less toxic achieved remission or a slowing of disease progression, according to research at the University of Pittsburgh Cancer Institute (UPCI), partner with UPMC CancerCenter. The findings were presented Sunday at the 56th American Society of Hematology Annual Meeting in San Francisco.

The research is important because most elderly patients diagnosed with AML can’t tolerate the aggressive chemotherapy needed and tend to have more aggressive disease than younger patients, making prognosis poor. So researchers, led by UPCI’s Annie Im, M.D., an assistant professor of medicine in Pitt’s Division of Hematology/Oncology, examined whether an epigenetic strategy using the drugs decitabine followed by cytarabine would help make other treatments more tolerable by reactivating genes that had previously been silenced by the malignancy.

“Outcomes are really poor in elderly patients who have AML because the only therapies we have are often too toxic to offer as treatment options, and the unmet need for novel therapies is dire,” Dr. Im said. “But we have shown that using this therapy in this patient population is safe and effective.”

In the study, 23 patients were evaluated after receiving what’s called an induction therapy of decitabine intravenously for five days followed by a standard dose of cytarabine intravenously for five days. Fourteen patients had complete remission and five patients had a complete remission with delayed bone marrow recovery. All patients except for two received two cycles of induction.

Researchers believe the drugs work because they help reactivate genes that had been silenced by the malignancy. In addition, evidence suggests that epigenetic priming by decitabine enhances the efficacy of cytarabine. The next phase of the trial will examine overall survival and the rate of adverse events, and include epigenetic correlative studies.

Gastroenterology Experts Present at AIBD 2014

PITTSBURGH, Dec. 8, 2014 – Faculty from the Division of Gastroenterology, Hepatology, and Nutrition were among the experts who presented at the recent 2014 Advances in Inflammatory Bowel Diseases, Crohn’s & Colitis Foundation’s Clinical & Research Conference in Orlando, Fla. Faculty research was presented in both oral and poster presentations, and covered a wide range of topics, including:

  • A Model Integrating Genetic and Environmental Factors Can Differentiate Crohn’s Disease from Ulcerative Colitis
    UPMC Co-Author: Richard Duerr, MD
  • The Patient-Centered IBD Medical Home: Will This Be the Future of IBD Healthcare Delivery?
    Presented by Miguel Regueiro, MD
  • E. Management of Psycho-Social Issues in IBD Patients: Case Studies
    Co-presented by Eva Szigethy, MD, PhD
  • Clinical Predictors of Moderate Depression and Suicidality in Adults with IBD
    UPMC co-Authors: Victor Chedid, MD, Jana Al Hashash, MD, Gregory Thorkelson, MD, Claudia Rivers-Ramos, MD, David Binion, MD, Miguel Regueiro,MD, Eva Szigethy, MD, PhD
  • What is the Optimal Medical Management of Post-Operative Crohn’s Disease?
    Presented by Miguel Regueiro, MD
  • Stop the Scanners! External Validation of Algorithms Predicting Complications in Patients with Crohn’s Disease Presenting to the Emergency Department
    UPMC Co-Author Jason Swoger, MD
  • Preventing and Treating Narcotic Dependence in Our IBD Patients
    Presented by Eva Szigethy, MD, PhD
  • IBD CONNECT: A Novel Inflammatory Bowel Disease Volunteer Program for Hospitalized Crohn’s Disease and Ulcerative Colitis Patients
    UPMC Co-Authors: Miguel Regueiro, MD, Eva Szigethy, MD, PhD

For more information on the conference, please visit AdvancesInIBD.com.

Pitt Experts Publish Findings in Robotics, Stem Cells, and BCI for Stroke Rehabilitation in AJPM&R

PITTSBURGH, Dec. 4, 2014 – Researchers at the University of Pittsburgh led by Michael L. Boninger, MD,  professor and chair in the Department of Physical Medicine & Rehabilitation and director of UPMC Rehabilitation Institute, published the current state and latest advances in robotics, stem cells, and brain-computer interfaces (BCIs) in rehabilitation and recovery for stroke in the American Journal of Physical Medicine & Rehabilitation.

Stroke is the fourth leading cause of death in the United States and affects approximately 800,000 people every year. Despite recent advances in prevention and therapy, there are more than 6 million stroke survivors living with disability. Recently, attention has turned toward applying robotics, stem cells, and BCIs to aid in brain repair and recovery.

The publication highlighted recent studies and clinical trials, as well as barriers associated with robotics, stem cells, and brain-computer interface technology for stroke rehabilitation. In conclusion, the team wrote, “robotics, stem cells, and brain-computer interfaces all have tremendous potential to reduce disability and lead to better outcomes for patients with stroke. Continued research and investment will be needed as the field moves forward. With this investment, the potential for recovery of function is likely substantial.”

Co-authors of the study were Lawrence R. Wechsler, MD, chair of the department of neurology at the University of Pittsburgh, and Joel Stein, MD, chief of the Division of Rehabilitation Medicine at Weill Cornell Medical College.

To view the full abstract, please visit PubMed.gov.

PET Scans Help Identify Effective TB Drugs, Says Pitt School of Medicine Study

PITTSBURGH, Dec. 3, 2014 – Sophisticated lung imaging can show whether or not a treatment drug is able to clear tuberculosis (TB) lung infection in human and macaque studies, according to researchers at the University of Pittsburgh School of Medicine and their international collaborators. The findings, published online today in Science Translational Medicine, indicate the animal model can correctly predict which experimental agents have the best chance for success in human trials.

In 2012, an estimated 8.6 million people in the world contracted TB, for which the first-line treatment demands taking four different drugs for six to eight months to get a durable cure, explained senior investigator JoAnne L. Flynn, Ph.D., professor of microbiology and molecular genetics, Pitt School of Medicine. Patients who aren’t cured of the infection – about 500,000 annually – can develop multi-drug resistant TB, and have to take as many as six drugs for two years.

“Some of those people don’t get cured, either, and develop what we call extensively drug-resistant, or XDR, TB, which has a very poor prognosis,” she said. “Our challenge is to find more effective treatments that work in a shorter time period, but the standard preclinical models for testing new drugs have occasionally led to contradictory results when they are evaluated in human trials.”

In previous research, Dr. Flynn’s colleagues at the National Institutes of Health found that the drug linezolid effectively treated XDR-TB patients who had not improved with conventional treatment, even though mouse studies suggested it would have no impact on the disease. To further examine the effects of linezolid and another drug of the same class, Dr. Flynn and her NIH collaborators, led by Clifton E. Barry III, PH.D., performed PET/CT scans in TB-infected humans and macaques, which also get lesions known as granulomas in the lungs. In a PET scan, a tiny amount of a radioactive probe is injected into the blood that gets picked up by metabolically active cells, leaving a “hot spot” on the image.

The researchers found that humans and macaques had very similar disease profiles, and that both groups had hot spots of TB in the lungs that in most cases improved after drug treatment. CT scans, which show anatomical detail of the lungs, also indicated post-treatment improvement. One patient had a hot spot that got worse, and further testing revealed his TB strain was resistant to linezolid.

The findings show that a macaque model and PET scanning can better predict which drugs are likely to be effective in clinical trials, and that could help get new treatments to patients faster, Dr. Flynn said. The scans also could be useful as a way of confirming drug resistance, but aren’t likely to be implemented routinely.

“We plan to use this PET scanning strategy to determine why some lesions don’t respond to certain drugs, and to test candidate anti-TB agents,” she said. “This might give us a way of tailoring treatment to individuals.”

The research team includes lead author M. Teresa Coleman and others from the Pitt School of Medicine and Children’s Hospital of Pittsburgh of UPMC; co-senior author Dr. Barry and others from the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health; as well as scientists from the International Tuberculosis Research Center in Changwon, Republic of Korea; Rutgers New Jersey Medical School; Frederick National Laboratory for Cancer Research; Yonsei University College of Medicine, Seoul, Republic of Korea; and the University of Cape Town, Rondebosch, South Africa.

Funding for this study was provided by the National Institute of Allergy and Infectious Diseases and the National Cancer Institute; the Ministry of Health and Welfare, Republic of Korea; and the Bill and Melinda Gates Foundation.

Link Exists Between White Matter and Concussion-Related Depression, Anxiety, Pitt Researchers Find

PITTSBURGH, Dec. 2, 2014 – White matter brain abnormalities in some patients with depression disorders closely resemble abnormalities found in patients who have experienced a mild traumatic brain injury (mTBI), more commonly known as concussion, according to new research presented by University of Pittsburgh School of Medicine researchers this week at the annual meeting of the Radiological Society of North America (RSNA).

The researchers, who also studied anxiety in concussion patients who underwent imaging, believe determining these white-matter injuries also could help guide treatment in people who suffer such symptoms, whether they are due to trauma or not.

White matter in the brain is made up of long, finger-like fibers projecting from nerve cells and is covered by a whitish fatty material. While gray matter, the part of our brain without the fatty covering, holds our knowledge, white matter is what connects different regions of gray matter, allowing different parts of the brain to communicate with one another.

Over the past several years, cognitive consequences of concussion have dominated the news.  Any association between concussion/mTBI and the development of psychiatric disorders hasn’t garnered the same level of attention.  Saeed Fakhran, M.D., assistant professor of radiology at Pitt and his team wanted to determine if a trauma to the brain could be found in imaging as an underlying cause of depression or anxiety in certain patients.

“We know that neuropsychiatric disorders like depression and anxiety can be as disabling as Alzheimer’s dementia and chronic traumatic encephalopathy, affecting a person’s quality of life, and are often accompanied by higher rates of obesity, substance abuse and even suicide,” said Dr. Fakhran. “We wanted to see if there were commonalities shared by patients with depression and anxiety disorders caused by brain trauma and those with non-traumatic depression.”

For this study, Dr. Fakhran and his team examined MRI scans performed in 74 concussion patients from 2006-14 using an advanced technique called diffusion tensor imaging.  Diffusion tensor imaging allows doctors to visualize the white matter and look for places where the white matter may be injured, resulting in decreased connections in the brain and post-concussion symptoms.  In patients with depression, researchers found injured regions in the reward circuit of the brain, which has also been found to be abnormal in patients with non-traumatic major depressive disorder.  Greater injury to the reward center of the brain correlated with a longer recovery time, similar to patients with non-traumatic major depressive disorder, the researchers said.

“Finding such similar injuries in mTBI patients with depression and major depressive disorder may suggest a common pathophysiology in both traumatic and non-traumatic depression that may help guide treatment,” said Dr. Fakhran. “The first step in developing a treatment for any disease is understanding what causes it, and if we can prove a link, or even a common pathway, between post-traumatic depression and depression in the general population it could potentially lead to effective treatment strategies for both diseases.”

While noting that continuing research is vital in this area, the researchers said their project was limited by its retrospective nature and moderate sample size. Because so few concussion patients undergo imaging, the researchers added that future, prospective research could benefit from following a larger group of patients. Moreover, their findings didn’t include irritability, the third neuropsychiatric symptom they set out to study – causing them to determine that not all such post-concussion/mTBI symptoms appear to result in discrete white matter injuries. It also was difficult to determine, they said, if pre-existing brain abnormalities rendered certain patients more susceptible to depression or anxiety.

Physicians and Researchers Present at AASLD 2014

PITTSBURGH, Dec. 1, 2014 – Faculty from the Division of Gastroenterology, Hepatology, and Nutrition and the Thomas E. Starzl Transplantation Institute were well-represented at The Liver Meeting® held by the American Association for the Study of Liver Diseases in Boston. Experts from the division gave oral and poster presentations on topics such as:

  • BPAR (Biopsy Proven Acute Rejection) During Protocolized Immunosuppression Withdrawal (ISW) is Readily Reversed in Pediatric Liver Transplant (Tx) Recipients
    UPMC Contributors: Veena Venkat, MD, George Mazariegos, MD, Anthony Demetris, MD
  • Incremental Dose Model Identified GSK3β and β-catenin as Potential Targets for Regenerative Therapies for Acetaminophen-Induced Acute Liver Failure
    UPMC Contributor: Satdarshan (Paul) Singh Monga, MD
  • Cost-Effectiveness of Novel Hepatitis C Drug Regimens Among Treatment-Experiences U.S. Veterans
    UPMC Contributors: Cindy Bryce, PhD, Michael Fine, MD, MSc, Chester Good, MD, MPH, Larissa Myaskovsky, PhD, Vinod Rustgi, MD, MBA, Allan Tsung, MD, Kenneth Smith, MD, MS
  • Infection Challenges in the Cirrhotic Patient
    UPMC Contributor: Kapil Chopra, MD
  • The Economic Impact of Sofosbuvir-and Simeprevir-Based HCV Treatment in the Unites States
    UPMC Contributors: Mark Roberts, MD, and Michael Dunn, MD
  • Predictors of Mortality in Patients With Low MELD on the Liver Transplant Wait List
    UPMC Contributors: Swaytha Ganesh, MD, Chandraprakash Umapathy, MD, Abhinav Humar, MD, Christopher Hughes, MD, Mark Sturdevant, MD, Elizabeth Kallenborn, MSN, RN, Vinod Rustgi, MD, MBA, Shahid Malik, MD, Amit Tevar, MD
  • HCV Infection in Opiod-Using (OU) Pregnant Women
    UPMC Contributors: Elizabeth Krans, MD, MSc, Vinod Rustgi, MD, MBA
  • All Oral Treatment for Genotypr 4 Chronic Hepatitis C Infection With Sofosbuvir and Ledipasvir: Interim Results from the NIAID SYNERGY Trial
    UPMC Contributor: Vinod Rustgi, MD, MBA
  • Prevalence of Precore and Dual Basal Core Promoter HBV Variants in a Racially Diverse Cohort of Patients With Chronic HBV Infection in North America
    UPMC Contributors: Obaid Shaikh, MD, Abdus Wahed, PhD
  • ABT-450/r/Ombitasvir + Dasabuvir With or Without Ribavirin in HCV Genotype 1-Infected Patients Receiving Stable Opioid Substitution Treatment: Pooled Analysis of Efficacy and Safety in Phase 2 and Phase 3 Trials
    UPMC Contributor: Vinod Rustgi, MD, MBA
  • Safety of ABT-450/r/Ombitasvir + Dasabuvir With or Without Ribavirin in HCV Genotype 1-Infected Patients ≥65 Years of Age: Results From Phase 2 and 3 Trials
    UPMC Contributor: Vinod Rustgi, MD, MBA

For more information on The Liver Meeting, please visit the conference page.

Pitt Team Finds Associations Between Biomarkers and Pain-Related Function in Older Adults With Low Back Pain

PITTSBURGH, Dec. 1, 2015 – Researchers at the University of Pittsburghexamined the relationship between serum biomarkers and self-reported pain intensity and pain-related function in older adults with chronic low back pain. Because current tools to assess lumbar spine pathology focus on imaging findings and do not address pain or catabolic activity of the tissue, the study aimed to understand the contribution of back pain to the function of older adults due to the increasing prevalence of low back pain associated with age and expectations of older adults to remain active.

Gwendolyn Sowa, MD, PhD, associate professor and Vice Chair for Clinical Outcomes and Quality Care in the Department of Physical Medicine and Rehabilitation at the University of Pittsburgh, was the lead author of the study, which was recently published in the Journal of the American Geriatrics Society. Dr. Sowa also is co-director of the Ferguson Laboratory for Orthopaedic and Spine Research at the University of Pittsburgh.

The study included participants ages 60 and older with axial low back pain without radiculopathy, previously diagnosed osteoarthritis of the knee or hip, or pain outside the low back that is more severe than the back pain. Participant questionnaires, plasma samples, physical performance tests, and MRIs were analyzed.

In the conclusion of their findings, the authors wrote, “serum biomarkers may be a metric for assessment of active disease in older adults, in whom imaging changes are ubiquitous. In addition, changing levels of biomarkers in response to activity suggests that they may be useful as metrics to measure treatment responses in future studies and may reflect potential targets for use in designing personalized treatment for older adults with low back pain.”

Additional authors of the study included Subashan Perera, PhD, Bernard Bechara, MS, Vikas Agarwal, MD, John Boardman, MD, Wan Huang, MD, Alejandra Camacho-Soto, MD, Nam Vo, PhD, James Kang, MD, and Debra Weiner, MD, all currently or formerly of the University of Pittsburgh.

To view the complete abstract, please visit PubMed.gov.

Physicians and Researchers Present at the 2014 Annual Meeting for the American Heart Association

The UPMC Heart and Vascular Institute was well-represented at the 2014 Annual Meeting for the American Heart Association in Chicago. Faculty research was featured in both oral and poster presentations throughout the conference, including:

Sunday, November 16: 

  • Heart Failure: CRT and Pacing (POSTER)
    Comparative Outcomes after Cardiac Resynchronization Therapy in Patients with Right Ventricular Pacing versus Native Wide Left Bundle Branch Block
    Presented by: Bhupendar Tayal, Antonia Delgado-Montero, Akiko Goda, Keiko Ryo, Samir Saba, Niels Risum, Hvidovre Sygehus, Peter Sogaard, John Gorcsan III
  • Heart Failure: CT and Pacing (POSTER)
    Global Longitudinal Strain Combined With Radical Strain Delay Before Cardiac Resynchronization Therapy is Associated With Long Term Survival
    Presented by: Antonia Delgado-Montero, Bhupendar Tayal, Keiko Ryo, Akiko Goda, David Schwartzman, Samir Saba, John Gorcsan III
  • Chronic Ischemic Heart Disease (POSTER)
    Prediction of Mitral Regurgitation Progression With Advanced Ischemic Cardiomyopathy – A Multi-Modality Study
    Presented by: Kenya Kusunose, Nancy Obuchowski, João Cavalcante, Rayji S. Tsutsui, Zoran B. Popovic, James D. Thomas, Milind Y. Desai, Scott D. Flamm, Brian P. Griffin, Deborah H. Kwon
  • Heart Rate-independent Qt Variability in Congenital Long Qt Syndrome (POSTER)
    Presented by: Jan Nemec
  • Vascular Disease and Pulmonary Hypertension (POSTER)
    Metabolic Syndrome and Pulmonary Hypertension Due to Left Heart Disease
    Presented by: Rebecca R. Vanderpool, Sebastian Shterental, Timothy N. Bachman, Mark T. Gladwin, Marc A. Simon

Monday, November 17:

  • Imaging Heart Failure Substrates for Prognosis (INVITED TALK)
    Presented by: Eric Schelbert
  • Echocardiography in the Context of Multi-Modality Imaging (POSTER)
    Echocardiographic Estimation of Myocardial Scar by Segmental Longitudinal Strain in Patients with Ischemic Cardiomyopathy and Left Bundle Branch Block: Comparison with Quantitative Cardiac Magnetic Resonance Imaging Late Gadolinium Enhancement
    Presented by: Bhupendar Tayal, Niels Risum, Hvidovre Sygehus, Antonia Delgado-Montero, Allan Iversion, Thomas Fritz Hansen, John Gorcsan III, Peter Sogaard
  • Echocardiography: Evaluation of RV function – Role of Strain Imaging (POSTER)
    Right Ventricular Remodeling is Additive to Global Longitudinal Strain in Predicting Long Term Survival in Patients with Pulmonary Hypertension
    Presented by: Akiko Goda, Keiko Ryo, Antonia Delgado-Montero, Bhupendar Tayal, Marc Simon, Michael A. Mathier, John Gorcsan III
  • Echocardiography: Evaluation of RV function – Role of Strain Imaging (POSTER)
    The Additive Effects of Tricuspid Regurgitation and Pressure Overload in Pulmonary Hypertension on Three-Dimensional Right Ventricular Mechanics and Patient Outcomes
    Presented by: Keiko Ryo, Akiko Goda, Antonia Delgado-Montero, Bhupendar Tayal, Marc A. Simon, Michael A. Mathier, John Gorcsan III
  • Progress in Clinical Pediatric Heart Failure/Transplantation (POSTER)
    Presented by: B. Feingold, C.M. Salgado, M. Reyes-Mugica, S. Drant, S.A. Miller, P. Kellman, E.B. Schelbert, T.C. Wong
  • Utility of the Wearable Cardioverter-Defibrillator for Patients With Newly Diagnosed Non-Ischemic Cardiomyopathy? (POSTER)
    Presented by: Madhur Singh
  • Bedside Ultrasound Evaluation of Right Atrial Pressure to Predict Acute Decompensated Heart Failure 30-Day Readmission
    Presented by: Fredrick G. Schnatz III, Sneha N. Parikh, Jonathan E. Leeman, Madhurmeet Singh, Flordeliza S. Villanueva, Marc A. Simon, John H. Pacella

Tuesday, November 18:

  • Microcirculation and Cerebral/Coronary/Peripheral (POSTER)
    Sonoreperfusion Therapyfor Microvascular Obstruction Using Microbubbles and Low Dose tPa
    Presented by: Sebastiaan Roos, Rick Schnatz, John Pacella
  • Dickinson W. Richards Lecture: Frontiers in Pulmonary Hypertension (ORAL)
    Adverse Right Ventricular Remodeling by Three Dimensional Echocardiographic Wall Motion Tracking in Pulmonary Hypertension is Associated with Patient Outcomes
    Presented by: Keiko Ryo, Akiko Goda, Antonia Delgado-Montero, Bhupendar Tayal, Marc A. Simon, Michael A. Mathier, John Gorcsan III
  • Risk Factors, Biomarkers, Risk Prediction II (POSTER)
    Higher Levels of Plasminogen-Activator Inhibitor I Are Associated with Progression of Coronary Artery Calcification in Middle-Aged Women: The Study of Women’s Health Across the Nation (SWAN) Heart Study
    Presented by: Norman C. Wang, Karen A. Matthews, Emma JM Barinas-Mitchell, Chung-Chou H. Chang, Samar R. El Khoudary
  • Emerging Technologies II (POSTER)
    Targeted Therapeutic Gene Knockdown Using Ultrasound and Microbubble-mediated Delivery of a Transcription Factor Decoy
    Presented by: Jonathan Kopecheck
  • Heart Failure: Exercise and More… (POSTER)
    Right Ventricular Function is Associated with Long Term Survival in Patients Undergoing Cardiac Resynchronization Therapy
    Presented by: Antonia Delgado-Montero, Bhupendar Tayal, Keiko Ryo, Akiko Goda, David Schwartzman, Samir Saba, John Gorcsan III
  • Vasodilator Therapy on Hemodynamics and Exercise Capacity in Patients With Exercise Induced Pulmonary Hypertension Due to Pulmonary Vascular Disease or Heart Failure With Preserved Ejection Fraction (POSTER)
    Presented by: David C. Ishizawar, Matthew Lander, Michael A. Mathier
  • Multimodality Imaging of Cardiac Stem Cells
    Presented by: Flordeliza Villanueva

For more information, visit the conference site.





Program Improves Diabetes Control in World’s Poorest Children, Pitt Public Health Finds

PITTSBURGH, Nov. 25 2014 – A nonprofit program that brings diabetes care and education to some of the world’s poorest children has successfully improved control of the disease, according to a University of Pittsburgh Graduate School of Public Health analysis published in the journal Diabetes Research and Clinical Practice. It is the first scientific evidence to show that improvement in long-term blood sugar control in type 1 diabetes is possible in sub-Saharan African youth.

The International Diabetes Federation Life for a Child (LFAC) program’s approach to providing care to children with type 1 diabetes in Rwanda led to major reductions in HbA1c, a long-term measure of blood sugar. The proportion of children who had an HbA1c level of more than 14 percent, a potentially lethal level, fell from 31 percent to 9 percent. The improvement was greatest in the children who had access to blood sugar testing supplies and regularly monitored their blood glucose levels.

“Type 1 diabetes can be a very difficult disease to manage, and, if not properly controlled, it is deadly,” said senior author Trevor Orchard, M.D., professor of epidemiology at Pitt Public Health. “When coupled with poverty, food insecurity and severely limited health care provision that many of the children in sub-Saharan Africa face, the need for proven programs to help these children control their diabetes becomes vital.”

Type 1 diabetes, usually diagnosed in children and young adults, happens when the body does not produce insulin, a hormone that is needed to convert sugar into energy.

LFAC supports the provision of insulin, glucose monitoring supplies, diabetes education, advice and training to children and youth with diabetes in developing countries. In Rwanda, the program provides assistance through the Association Rwandaise des Diabetiques (ARD) in the city of Kigali.

Dr. Orchard and his team followed and regularly measured the HbA1c levels in 214 people under age 25 who enrolled in the program between June 2009 and November 2010.

HbA1c develops when sugar binds to hemoglobin, a protein within red blood cells, in the blood. The higher the HbA1c, the greater the risk of developing diabetes-related complications, like heart disease, blindness and nerve damage. Those without diabetes typically have an HbA1c between 4 and 5.7 percent. For people with diabetes, an HbA1c level of less than 7 percent is considered good control.

In the Rwandan children that Dr. Orchard’s team followed, the average HbA1c initially was 11.2 percent. After two years in the program, the average fell to 9.8 percent.

Dr. Orchard became involved in the program in Rwanda in 2007 when it had only 25 children. LFAC has now enrolled more than 1,000 children and youth. Pitt Public Health sends at least one graduate student every year to assist with the program and the required annual assessments of the children enrolled. Dr. Orchard and a colleague from Northwestern University in Chicago, Deborah Edidin M.D., also visit Rwanda regularly to help develop and provide care and education for the children.

“It is very encouraging to see the Rwandan children get better control of their blood sugar levels thanks to this unique collaborative effort between the LFAC, ARD and Pitt,” said Dr. Orchard. “However, more work is needed. Only about 12 percent of the Rwandan children met American Diabetes Association glucose control goals, compared with 32 percent of U.S. children.”

A key part of controlling type 1 diabetes is regular blood sugar monitoring, which allows patients to adjust their insulin levels based on test results. Children who were better able to monitor their blood sugar had better HbA1c levels. In some cases, a lack of testing supplies prohibited children from testing their blood sugar as frequently as recommended.

Disturbingly, Dr. Orchard’s team also found that, as HbA1c levels improved, high blood pressure emerged as a major problem such that over 40 percent of the youth were hypertensive.

“This is troubling,” said Dr. Orchard. “Many of our participants were very young children during the Rwandan genocide of 1994 and grew up malnourished and underweight. It is possible to attribute some of the increasing blood pressure to weight gain and rehydration after enrollment in the program. Salt also often is used in food preparation and preservation in sub-Saharan Africa, so this may be a factor as well. Unfortunately, very few participants are able to take blood pressure medication due to limited supplies and prohibitive prices.”

Dr. Orchard noted that continued study is needed to better understand the causes of the high blood pressure among the Rwandan children receiving care for type 1 diabetes, as well as to determine how best to develop a sustainable program to maintain this improved care.

Additional researchers on this project are Sara L. Marshall, Ph.D., Vincent C. Arena, Ph.D., Dorothy J. Becker, M.B.B.Ch., Clareann H. Bunker, Ph.D., Ronald E. LaPorte, Ph.D., and Laurien Sibomana, M.S., all of Pitt; Graham Ogle, M.B.B.S., of the International Diabetes Federation Life for a Child Program and Australian Diabetes Council; and Crispin Gishoma, Francois Gishoma, and Veaste Kaberuka, all of the Association Rwandaise des Diabetiques.

This work was largely funded by donations to the Life for a Child –Pitt Initiative. Directions for donating to the initiative can be found at: http://www.upmc.com/lifeforachildprogram

Pitt Public Health Biostatistician Receives Fellowship from World’s Top Scientific Society

PITTSBURGH, Nov. 24, 2014 – James J. Schlesselman, Ph.D., professor emeritus of the University of Pittsburgh Graduate School of Public Health, has been named a Fellow of the American Association for the Advancement of Science (AAAS).

AAAS is the world’s largest general scientific society, fellowship in which is an honor bestowed upon AAAS members by their peers. This year, 401 members will be awarded fellowship to recognize their scientifically or socially distinguished efforts to advance science or its applications. This year’s AAAS Fellows will be formally announced in the journal Science on Friday.

Dr. Schlesselman, who retired from Pitt Public Health’s Department of Biostatistics, remains active in the field of biostatistics and epidemiology, doing consulting work in the United States and abroad.

“To be recognized by the AAAS for my work is humbling. All that I sought to do over the years is encapsulated in the title of an article by the late mathematical statistician Jerzy Neyman: ‘Statistics – Servant of All Sciences,’” which ran in Science in 1955, said Dr. Schlesselman.

As part of the AAAS Section of Statistics, Dr. Schlesselman was elected as an AAAS Fellow for his body of work in statistical methods and leadership; key studies of vaccines, nutrition and reproductive health; and expert advice to international and U.S. governmental agencies.

“This AAAS Fellowship recognizes Dr. Schlesselman’s significant methodological contributions and leadership as a statistical scientist. We are very fortunate to have him as our colleague in the discipline and in our department,” said Sally C. Morton, Ph.D., professor and chair of the Department of Biostatistics at Pitt Public Health.

Dr. Schlesselman received his Ph.D. in statistics from Princeton University in 1971 while working as a biostatistician at the National Institutes of Health (NIH) in studies of human reproduction, vaccine field trials, nutrition and disabilities. He served at the NIH until 1981, rising to the rank of chief of the biometry branch in the National Institute of Child Health and Human Development.

From there he served on the faculty at the Uniformed Services University of the Health Sciences in Bethesda, Md., Pitt’s School of Medicine and the University of Miami before returning to Pitt in 2004 to lead the biostatistics facility at the University of Pittsburgh Cancer Institute.

Over the years, Dr. Schlesselman has been called on to advise and work with components of the World Health Organization, International Atomic Energy Agency, U.S. Food and Drug Administration, Centers for Disease Control and Prevention,  the NIH and the Agency for International Development, among others.

The tradition of AAAS Fellows began in 1874. Dr. Schlesselman and the other 400 fellows will be presented with an official fellowship certificate and rosette pin on Feb. 14, 2015, during the AAAS Annual Meeting in San Jose, Calif.

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